For many, the idea of “switching” genders suggests some mental illness, kink or sexual preference. But scientists explain transgenderism in biological terms. John doesn’t become Jane by choice, or out of confusion. In the brain that creates our sense of self, he is already she—even before birth.

These studies started appearing in the 1990s, when a team of researchers in the Netherlands performed autopsies on six male-to-female transsexuals. Previously, neuroscientists had discovered that the bed nucleus, a region of the hypothalamus with receptors for male and female sex hormones, is much larger in men than women. But in each of the six transsexuals—all born male—the bed nucleus was far closer in size to a female’s. The findings suggested that neurologically, transgender people are born, just as they always claimed, in the wrong body.

Since then, researchers have confirmed and expanded these findings. Today, while there isn’t a medical consensus yet, medical experts believe transgenderism is related to hormone exposure during pregnancy. In other words, being “trans” is biological—something a baby acquires in utero. “The science has been very helpful,” says Jacsen Callanan of the Mazzoni Center, the health and wellness center for the city’s LGBT community. “Parents, and trans people themselves, can say this experience is rare, but naturally occurring.”

But there remains a deep cultural bias against transgenderism. From the moment a pregnancy is announced, the question is asked: Boy or girl? The answer becomes the foundation of our identity. Legally speaking, the transgender can have the sex on their birth certificates changed. But politically, language can get tricky when you tell a transgender person’s life story. (For the purposes of this story, we shift pronouns—from he to she or she to he—at the moment the characters in the story “transition” to live publicly as the opposite gender.)

While the transgender have become more visible in the past few years, they’ve been among us far longer. In the 1970s, Rachel Harlow, a Philadelphia transsexual formerly known as Richard Finocchio, ran the fashionable club Harlow’s on Bank Street; she became the center of a scandal when she began an affair with City Councilman John Kelly Jr., the brother of Grace Kelly. Four decades later, the transgender remain shrouded in myth. The desire to wear the other sex’s clothes—for a supposed boy to steal his sister’s underwear—is often mistaken for cross-dressing, a sexual fetish. But for the transgender, putting on the opposite sex’s underwear is an attempt to alleviate a source of suffering—to make the outside match what’s inside.

Because the transgender often undergo surgery to refashion their sex organs into their opposite, we think of them strictly in sexual terms. But psychologists suggest a mental exercise: Imagine, they say, you are a man who wakes up one day to see that your penis is gone; you now have a vagina.
Imagine the freakishness, the sense of woundedness and alienation, you’d feel from your own body.

Sit with that.

The transgender feel this way every day. One family told me their five-year-old daughter insisted on wearing underwear into the shower because she couldn’t bear to see the body her brain rejected. “Transgender people often report identifying so much with the body opposite to theirs,” says Maureen Osborne, a psychologist in Malvern, “that puberty comes as a shock. They tell themselves as children that somehow this will change on its own. And when it doesn’t, it’s devastating.”

For generations, being transgender has stood as a kind of death sentence. Ostracized by families and communities, the transgender suffer greater-than-average rates of poverty, homelessness and drug addiction. According to statistics gathered by the National Transgender Discrimination Survey, 26 percent of trans people have lost a job for being trans. Trans people are also assaulted at rates higher than any other minority. In December 2002, Nizah Morris, a trans woman, was found on the side of the road in Center City, bleeding from a fatal head wound just minutes after she’d been loaded into the back of a police car. (The police claimed officers let her off unharmed; the police and D.A.’s office have been criticized for withholding information. Only the dogged reporting of Timothy Cwiek of the Philadelphia Gay News has kept the murder in public view.) A stunning 40 percent attempt suicide. Yet despite existing as a kind of lower caste, the transgender are advancing, from lonely nights and thoughts of suicide to life, out here, with the rest of us.

Up until five years ago, the transgender tended to transition—to live publicly in a new gender—only after decades of misery. “All my life I knew something was wrong,” says Renee Ramsey, an 81-year-old trans woman who recently moved to Summerville, South Carolina, from Bergen County, New Jersey. “My birth name was Richard, and everyone thought of me as a man. But inside, I always felt different.”

Richard Ramsey identified with the females he knew. He experimented, playing traditionally feminine games like dress-up and house. But he remained “Richard.” He stole his mother’s underwear, and wore it when he was alone. When he was caught, his parents took him to a psychiatrist, who declared his desire “a phase.”

What followed is now known by psychologists as the “flight to masculinity.” Richard joined the military; he married, twice, conceiving four children, and got divorced. “I tried,” Renee says today, “to make the best of it.”

In fact, Richard spent a lifetime fighting to “be a man” before consulting Sherman Leis, a Bala Cynwyd plastic surgeon, about “gender reassignment” surgery. The desire to live in the right body for some measure of days before dying compelled Ramsey to undergo the physically draining procedure at age 77. “I’m finally happy,” she says.

In the past several years, there’s been something of a generational shift in who is “coming out” as transgender. Statistics are scarce, but local surgeons and psychologists report that the number of young people seeking treatment, sometimes including surgery, has grown drastically, from maybe five percent of their practices to 30 percent today.

There are a number of reasons for this. More trans people are outing themselves in the public eye (see: Chaz Bono; former Navy SEAL Kristin Beck). But the most important shift may be the availability of information. Just 15 years ago, learning about transgenderism involved an anxiety-producing trip to a public library. Now a child, or a parent like Patrice Golgata, can research without leaving the house. The result is a watershed moment for the transgender. As (most of) America celebrates the Supreme Court’s recent ruling in favor of gay marriage, the transgender likely stand on the cusp of their own battle for civil rights—with Philadelphia at the epicenter.

Of the dozen or fewer doctors in North America who regularly perform sex reassignment surgery, three operate in the Philly suburbs; one of the leading psychologists helping transgender kids and their families is located in Wayne. This all happened largely by accident. But the result is that a great, even historical drama is playing out here, in which some parents are acting—spurred by primal emotions of love and fear—to do nothing less than save the lives of their children.

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